Transfusion‐associated circulatory overload (<scp>TACO</scp>) and potential risk factors among the inpatient US elderly as recorded in Medicare administrative databases during 2011

Menis, Mikhail; Anderson, Steven A.; Forshee, Richard A.; McKean, Stephen; Johnson, Chris; Holness, Leslie; Warnock, Rob; Gondalia, Rahul; Worrall, Chris; Kelman, Jeffrey A.; Ball, Robert; Izurieta, Héctor S.

doi:10.1111/vox.12070

Cited by 67 publications

(61 citation statements)

References 24 publications

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“…A number of these findings are consistent with risk factors previously described in heterogeneous patients populations 8,13,30 . Uniquely, we have demonstrated an increased risk of TACO in those coming to emergency surgery.…”

Section: Discussionsupporting

confidence: 91%

“…Matching based upon this variable was pursued with the aim of removing this risk factor as a confounder of additional risk factors of interest. Similarly, age and sex have previously been shown to be strongly associated with TACO in non-surgical populations 10,13,18,25,26 . Cases and controls were both selected from a cohort of adult patients recently identified at our institution who were transfused while undergoing non-cardiac surgery in the calendar years 2004 or 2011 6 .…”

Section: Methodsmentioning

confidence: 66%

“…Variables considered as potential risk factors for TACO were identified based upon biologic plausibility and by review of the available literature 8,13,18,25,26 . These elements were extracted from the electronic medical record (EMR) using institutional databases that have been previously validated 28,29 .…”

Section: Methodsmentioning

confidence: 99%

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Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload

et al. 2017

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Background Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes. Methods In this case–control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared. Results For this cohort, the mean age was 71 yr and 56% were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33%; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84%). Conclusions Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of intraoperative blood transfusions and nonsanguineous fluid therapies, particularly in patients with chronic kidney disease, left ventricular dysfunction, chronic β-blocker therapy, and those requiring emergency surgery.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 66%

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Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload

et al. 2017

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“…Bolniki s hudo kronično anemijo (Hb < 50g/l) imajo hiperkinetičen krvni obtok, ki se slabo odziva na spremembe prostornine krvi. V več kot 20 % primerov so bolniki, pri katerih je prišlo do TACO, prejeli samo 1 enoto krvi (24)(25)(26). Klinična slika se razvije nekaj ur po transfuziji (skoraj vedno v okviru 6 ur) in se kaže kot dispneja, ortopneja, cianoza, tahikardija ter periferni edemi.…”

Section: Tacounclassified

Respiracijske transfuzijske reakcije

Marić¹,

Mlakar

Bricl³

2017

SlovMedJour

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IzvlečekTransfuzijske reakcije niso pogoste, vendar kljub temu verjetno pogostejše, kot jih ocenjujemo na splošno, saj je prepoznavanje in poročanje o transfuzijskih reakcijah še vedno pomanjkljivo. Čla-nek opisuje najpogostejše respiracijske transfuzijske reakcije, patofiziologijo le-teh, klinično sliko in zdravljenje. Med primarnimi transfuzijskimi reakcijami so najpomembnejše: s transfuzijo povezana akutna okvara pljuč oz. TRALI, s transfuzijo povezana volumska preobremenitev oz. TACO ter s transfuzijo povezana dispneja oz. TAD. Pri TRALI pride do aktiviranja imunskega sistema, katerega posledica je povečana prepustnost bazalne membrane v pljučnih mešičkih, kar vodi v nekardiogeni pljučni edem. Zdravljenje je podporno z dodajanjem kisika, tekočin ob hipotenziji, v hujših primerih dihalne odpovedi tudi mehansko predihavanje. Klinična slika TACO je kardiogeni pljučni edem, do katerega pride zaradi volumske obremenitve pri predisponiranih osebah, ki so: dojenčki, starostniki, bolniki s srčnim popuščanjem, anemijo in bolniki s pozitivno tekočinsko bilanco. TACO zdravimo po načelih zdravljenja kardiogenega pljučnega edema z dodajanjem kisika, diuretiki, po potrebi pa tudi z neinvazivnim ali invazivnim mehanskim predihavanjem. Pri TAD pa gre za etiološko nepojasnjeno dispnejo, ki se pojavi po transfuziji in je ne moremo opredeliti kot TACO ali TRALI, prav tako pa je ne pojasnijo bolnikove kronične bolezni. Ponavadi je TAD blaga reakcija. Čeprav transfuzijske reakcije niso zelo pogoste, je znanje o prepoznavanju, zdravljenju in preprečevanju respiracijskih transfuzijskih reakcij nujno potrebno, da se preprečijo resne posledice pri bolnikih. AbstractRespiratory transfusion-related reactions are not very frequent, partly also because recognition and reporting transfusion reactions is still underemphasized. This article describes the most important respiratory transfusion reactions, their pathophysiology, clinical picture and treatment strategies. Respiratory transfusion related reactions can be primary or secondary. The most important primary transfusion-related reactions are TRALI -transfusion-related acute lung injury, TACO -transfusion-associated circulatory overload, and TAD -transfusion-associated dyspnea. TRALI is immuneassociated injury of alveolar basal membrane, which becomes highly permeable and causes noncardiogenic pulmonary edema. Treatment of TRALI is mainly supportive with oxygen, fluids (in case of hypotension) and in cases of severe acute respiratory failure also mechanic ventilation. TACO is caused by volume overload in predisposed individuals, such as patients with heart failure, the elderly, infants, patients with anemia and patients with positive fluid balance. Clinical picture is that of a typical pulmonary cardiogenic edema, and the therapy is classical: oxygen and diuretics, and in severe cases also non-invasive or invasive mechanical ventilation. TAD is usually a mild reaction of unknown cause and cannot be classified as TACO or TRALI, nor can it be ascribed to patient's preexisting diseases. ...

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“…French studies show that blood transfusions have better outcomes in the elderly [11–13], in whom low rates of adverse reactions have been reported [14–16]. Analyses of Medicare databases show increased occurrence of febrile non-hemolytic transfusion reaction and transfusion-related acute lung injury and decreased occurrence of transfusion-associated circulatory overload in the over-80s, compared with patients aged 65–79 [17–19]. …”

Section: Introductionmentioning

confidence: 99%

Blood transfusion in elderly patients with chronic anemia: a qualitative analysis of the general practitioners’ attitudes

et al. 2017

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BackgroundBlood transfusion in chronic anemia is not covered by guidelines specific to older adults. When they consider that this treatment is necessary in elderly patients, French general practitioners (GPs) contact a hospital specialist to plan a transfusion.MethodsTwenty French GPs were questioned individually regarding their approach to blood transfusion using semi-structured interviews. Each interview was recorded, typed up verbatim and then coded using an inductive procedure by theme, in a cross-over design (two researchers) in two phases: analysis and summary, followed by grouping of the recorded comments.ResultsThe criteria for transfusion were hemoglobin level < 8 g/dL and cardiac comorbidities. Some geriatric issues, such as cognitive disorder or dependence, were considered, either as aspects of frailty favoring transfusion or as markers of reduced life expectancy that limit care. Falls and fear of an unpleasant death from anemia prompted GPs to order blood transfusion. The patient’s family provided guidance, but the patient was not routinely consulted. The specialists were rarely asked to participate in decision making. GPs’ perceptions were ambivalent: they considered transfusion to be extraordinary and magical, but also pointless since its effects are transient.ConclusionThe decision to give a transfusion to an elderly patient with chronic anemia is deemed complex, but GPs seem to take it alone, sometimes guided by the patient’s family. The drawing up of an advance care plan could help involve the patient in decision making.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0647-8) contains supplementary material, which is available to authorized users.

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Transfusion‐associated circulatory overload (TACO) and potential risk factors among the inpatient US elderly as recorded in Medicare administrative databases during 2011

Cited by 67 publications

References 24 publications

Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload

Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload

Respiracijske transfuzijske reakcije

Blood transfusion in elderly patients with chronic anemia: a qualitative analysis of the general practitioners’ attitudes

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